A non-government entity
Wellpoint Medicare Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Wellpoint Medicare Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Wellpoint Medicare Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Wellpoint Medicare Advantage (HMO-POS) is a HMO-POS plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select Counties in New Jersey. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Wellpoint Medicare Advantage (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Wellpoint Medicare Advantage (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Wellpoint Medicare Advantage (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7950.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Wellpoint Medicare Advantage (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Wellpoint Medicare Advantage (HMO-POS) plan has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $7 copay at preferred pharmacies or a $12 copay at standard pharmacies, while standard mail order has no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs.
Additional Benefits
The Wellpoint Medicare Advantage (HMO-POS) plan offers a range of covered services with varying cost-sharing. You'll find benefits like inpatient hospital stays with a copay, outpatient services, and coverage for emergency services. The plan also includes vision and dental coverage, with some services having no copay. Additional benefits include home health services with no copay, and coverage for hearing exams and hearing aids. The plan also covers primary care physician visits, preventive services, and home infusion bundled services. However, certain services like private duty nursing and some other "Other Services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90. Additional days for both inpatient hospital services are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $375, and observation services have a $375 copay. Ambulatory Surgical Center (ASC) Services, and outpatient blood services have no copay. Individual and group outpatient substance abuse sessions have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Wellpoint Medicare Advantage (HMO-POS) plan, but requires prior authorization. You will pay a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $285 copay, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Wellpoint Medicare Advantage (HMO-POS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay (prior authorization required), occupational therapy services with a $35 copay (prior authorization required), physician specialist services with a $25 copay (prior authorization required), mental health specialty services with a $40 copay for individual and group sessions (prior authorization required), other health care professional services with a copay between $5 and $20 (prior authorization required), psychiatric services with a $40 copay for individual and group sessions (prior authorization required), physical therapy and speech-language pathology services with a $25 copay (prior authorization required), additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay (prior authorization required). Podiatry services are not covered.
Preventive Services See details
Preventive services include Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services. The plan covers additional services such as fitness benefits, and remote access technologies with no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, with a $25 copay, and prescription hearing aids, which are covered up to a maximum of $2000 per year. Routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. OTC hearing aids are covered with no copay up to a maximum of $300 per year, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Wellpoint Medicare Advantage (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with a $0 copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, but upgrades are not covered. Eyewear has a combined maximum plan benefit of $150 per year.
Dental Services See details
Dental Services are covered, with no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. Other Dental Services have a maximum plan benefit coverage of $1,000 every year, and all restorative services have a $0 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Wellpoint Medicare Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and require prior authorization, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Wellpoint Medicare Advantage (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $90, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $30 and a coinsurance of at least 20%, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a copay of $20.
Home Health Services See details
Home Health Services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but no specific sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Wellpoint Medicare Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Under "Other Services", acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items and Meal Benefits are covered with no copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved